Coexisting hypertension (HTN) and obesity may substantially increase heart failure (HF) risk, according to a large cohort analysis published in the American Journal of Hypertension. The study also assessed the feasibility of a proposed clinical obesity definition based on excess adiposity with organ dysfunction or functional limitation.

Data were analyzed from the UK Biobank (n=444,754) and the Tongzhou Cohort (n=10,459). Hypertension was defined as physician-diagnosed hypertension, blood pressure ≥140/90 mmHg, or antihypertensive treatment. Obesity was assessed using body mass index (BMI)-defined obesity, central obesity, a combined BMI plus central obesity phenotype, and clinical obesity.

Participants were divided into four categories: neither hypertension nor obesity, obesity alone, hypertension alone, and coexisting hypertension with obesity. Kaplan–Meier methods and multivariable Cox regression models were used to estimate HF risk and to evaluate the combined effects of elevated blood pressure and pre-obesity.

Mean age was 58.15 ± 6.84 years in the UK Biobank and 59.42 ± 6.29 years in the Tongzhou Cohort. Depending on the adiposity definition applied, coexistence of hypertension and obesity was present in 18.0% to 25.9% of UK Biobank participants and 23.1% to 37.3% of Tongzhou participants.

Across multiple obesity definitions, participants with both hypertension and obesity consistently had the highest HF risk. Among those without either condition, the combination of elevated blood pressure and pre-obesity was also associated with increased HF risk.

These findings suggest that the coexistence of hypertension and excess adiposity identifies a group at particularly high HF risk, while risk may begin to rise before established disease develops.